MEDICARE: MRS. MARY BETH GREENBERG RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	R148184	MD

General Provider Information

NPI Number	:	1881666758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY BETH GREENBERG RN

Provider Business Mailing Address
First Line	:	1722 FAIRVIEW AVE
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-4708
Country	:	US
Telephone Number	:	703-298-5770
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 WARRINGTON AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20374-5022
Country	:	US
Telephone Number	:	202-433-4050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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